I have been on an antagonist protocol again this time at the max of 450 Follistim a day, however at only 75 . In Vitro Fertilisation (IVF) In this section If you have been referred for IVF treatment at Saint Mary's, we ask both partners to watch this video which describes the process, success rates and risks of fertility treatment. Nov 16, 2013 at 11:32 AM. While IVF can be performed without ovarian stimulation (called natural cycle IVF) , to increase the success rates and number of eggs and embryos available, typically an ovarian stimulation protocol is needed. The success rate of IVF is higher if the treatment is performed at a younger age. Your husband commences Doryx 100mg twice a day for 7 days when you commence Gonal F / Puregon. After spending a ridiculous amount of time reading about the differences between the two, this systematic review from 2017 seems to be the most comprehensive/updated literature I have found comparing the two: 1)GnRH antagonist protocols have lower OHSS rates than long agonist. You'll call your clinic on Day 1 of your period. 7. It involves the fewest number of injections and is effective for the majority of patients. The first question is naturally, "which protocol is more likely to deliver a baby," and when investigators looked at the two most popular strategies, "Long Agonist" and "Antagonist," it became clear both were equally effective in the general IVF population. Short protocols are better for your body. It's suitable for people with a wide range of fertility issues and is one of the most commonly used and successful treatments available for many people. Stimmed for 7 days. The you'll go in to the clinic on Day 2 or 3 for an ultrasound and bloodwork. . Despite these disadvantages, the use of the long protocol of GnRH agonist has consistently produced the best results from IVF . Therefore, the aim of this retrospective study was to explore rFSH treatment without rLH supplementation and antagonist treatment and to evaluate the best predictors for the success of the GnRH antagonist protocol in reproductive women undergoing IVF/intracytoplasmic sperm injection (ICSI)-ET treatment in fresh cycles. IVF stimulation protocols. - posted in IVF Ages 35+: Hello ladies, I had a cancelled IVF last month (due to low estrogen and poor response). GnRH antagonist protocols have several advantages over GnRH agonists protocols. There is two types of IVF cycle; long or short protocol. Femara 2.5 mg (Letrezole) Gonal-F and Menopur. 1 was frozen. There are typically three types of short protocol IVF. Effects of cetrorelix versus ganirelix in gonadotropin-releasing hormone antagonist cycles for preventing premature luteinizing hormone surges and on clinical outcomes of IVF . A large review of over 50 studies found that success rates for the IVF short protocol are significantly lower than for the standard long protocol. I have been on an antagonist protocol again this time at the max of 450 Follistim a day, however at only 75 . For 10 days, you'll take follicle-stimulating hormone (FSH) and lutenizing hormone (LH . The challenge with using a birth control pill, for some women, is that even a low dose pill (Alesse, Yasmin) for a short period (2 weeks) is too suppressive. The antagonist protocol is definitely easier than the long agonist protocol. 1st: Flare; 2nd: Antagonist - patients averaged 4.60 more eggs in the 2nd cycle; Fertilization rate. Recombinant luteinizing hormone supplementation in women undergoing in vitro fertilization/ intracytoplasmic sperm injection with gonadotropin releasing hormone antagonist protocol: a systematic review and meta-analysis. In vitro fertilisation (IVF) IVF is a type of fertility treatment where fertilisation takes place outside the body. Down-Regulation Protocol: Day 1: The standard GnRH-a long protocol is the vital one in China due to its association with steady and higher clinical pregnancy rates in fresh embryo transfer (ET) in patients undergoing in vitro fertilization (IVF) . Previous endocrine lab tests on day 2 3 or 4 (Estrogen, Follicle Stimulating Hormone-FSH and AMH), as well as the baseline ultrasound (US) to count the number of small antral follicles (AFC) indicate the woman's "ovarian reserve" of eggs or 'egg supply' and helps determine the medication dosage and the IVF protocol to be used for stimulation of the ovaries. Purpose of this presentation . Live birth rates are 50% in women less than age 35 and approximately 25% in women between the ages 40 to 42 per fresh IVF cycle. The suppression of gonadotropin hormones, as in the antagonist protocol of IVF, is not done in this procedure so your body will never go into the temporary menopausal stage. IVF antagonist cycle. During an IVF cycle certain medications are used to superovulate the ovaries in order to produce numerous of eggs. In the general population, both Long Agonist and Antagonist protocols have similar success rates. The number of daily injections are fewer (4 to 5 days) of antagonists versus 3-4 weeks of agonists) and the length of time to stimulate the follicles to maturity is one or two days shorter, so you may need less total gonadotropins. Table 3 represents the IVF Antagonist group, which involves a younger cohort of patients with a CP rate of 26% on day 7 and 35% on day 14. These medications may be given in a variety of combinations called protocols. For instance, a woman under age 35 who used her own eggs had a 37.6% chance of having a singleton (one baby) using IVF in 2018 . You may be instructed to use birth control pills prior to starting an IVF cycle. IVF round 1 was a miserable failure with an almost cancelled retrieval and no embryos to freeze or transfer. Lowers absolute risk of OHSS by 2.5 %. My first was a c/p, but then IVF#2 worked. Usually, it is a good idea to try to get about 10-12 eggs at each egg retrieval procedure. The medications stimulate (and are derived from . Xiong, Y, Bu, Z, Dai, W et al. IVF protocols. The IVF Antagonist Protocol, Explained. Cetrotide is a GnRH antagonist drug. At this point, your doctor will be able to clear you to begin the cycle. Cleveland Clinic. Two main kinds of protocols exist: long and short. With each, the goal is to retrieve the optimal number of eggs required to obtain enough healthy embryos to result in at least one pregnancy. Since it is 6-8 times higher with "conventional" With "conventional IVF" it follows that for . In the single dose protocol, a 3 mg dose of GnRH antagonist given on cycle day 7 during ovarian stimulation was shown to prevent a premature LH surge ( Olivennes et al ., 1998 ). 9 eggs were mature. I like OCP-antagonist cycles, and have had a lot of success with them recently. Memorial Sloan Kettering Cancer Center. Therefore, the aim of this retrospective study was to explore rFSH treatment without rLH supplementation and antagonist treatment and to evaluate the best predictors for the success of the GnRH antagonist protocol in reproductive women undergoing IVF/intracytoplasmic sperm injection (ICSI)-ET treatment in fresh cycles. Qiao et al reported that the normal responders treated with the GnRH antagonist protocol exhibited the same high success rates as women treated with the long GnRH agonist protocol . Gonal F, Puregon or Menopur) are injected daily into the subcutaneous tissue of your thigh or abdomen to stimulate the growth of the follicles in the ovaries. In the run-up to sperm collection on egg retrieval day, time the last ejaculation 48 to 72 hours before the big day. Zhang J, Zhou X, Chen Y, et al. The short protocol or antagonist cycles are often suggested for patients who have a Polycystic ovarian syndrome, as this is used to reduce the risk of OHSS (ovarian hyperstimulation), a side effect of IVF. I did the short protocol, which my doc said is better for women who they expect to be poor responders based on their bloodwork or other factors. I'm 37, we have done two IVF cycles this year. As the name suggests, short protocol IVF is a shorter process and is sometimes used when a woman has not produced that many eggs under the long protocol process, or in women with reduced ovarian reserve and/or older than 39 years, or in women with polycystic ovaries . Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate • Embryo Banking/Stockpiling: Slows the "Biological Clock" and offers a Selective Alternative to IVF-Egg Donation. Compared to patients treated with the antagonist protocol, patients treated with the agonist protocol demonstrated a significantly higher number of oocyte retrieved and mature oocytes production (with P value <0.05), while the cycle cancellation rate was similar (7,19,22). given, without affecting the success of your treatment •Egg collection occurs approximately 36 hours after the . Let's look at the main types of IVF protocols used in VittoriaVita in detail. Antagonist Protocol or Short Protocol: This is the most commonly used IVF protocol. The antagonist protocol usually begins with the onset of your menses, either on Day 2 or 3. A large review of over 50 studies found that success rates for the IVF short protocol are significantly lower than for the standard long protocol. Treatment outcome and rates of OHSS were compared in patients with PCOS who underwent assisted conception with either IVM or IVF with GnRH-antagonist protocol between 2006 and 2011. The researchers reported that pregnancy rates were 23.8% compared to 27.4% and birth rates were 21.2% compared to 24.1% ( GnRH antagonist versus long agonist protocols in IVF: a systematic review and . The long protocol is just that, long, and although it is very efficient, prolongs the overall time of treatment. Lupron, Buserelin, Nafarelin, and Synarel) or a GnRH antagonist (e.g. Stimmed for 12 days and had retrieval on day 14. The decrease in the success rates with IVF or any infertility treatment is due to the decreasing number of eggs within the ovaries. Medication used for Controlled Ovarian Hyperstimulation (Ovulation Induction) Before the IVF Cycle. There are several IVF protocols that can be used to stimulate the ovaries of in vitro fertilization (IVF) patients. The only side effect was itchiness at the injection site. I did a flare protocol with microdose lupron but also ganirelix for the first few days. We now know that some form of pituitary blockade, either in the form of a GnRH agonist (e.g. The protocol varies by stage and individual Doctors may vary it slightly but in the general protocol works something like this: 1. 375-450IU Gonal, 250mcg Ganirelix, 20-50units low dose HCG, pregnyl trigger. We now know that some form of pituitary blockade, either in the form of a GnRH agonist (e.g. Commence Baby Asprin (Astrix, Cartia, Cardiprin) when you commence Syneral / Lucrin. An option gaining momentum is egg retrieval, fertilisation, then embryo freezing. Ganirelix injection. High numbers of oocytes produced with the agonist long protocol . Data comparing the relative success of these two treatments is, however, lacking. 2- Antagonist Protocol. PDF | Introduction: In-vitro Fertilisation-Intracytoplasmic Sperm Injection (IVF-ICSI) is a modern technology where a sperm is injected into an ovum.. | Find, read and cite all the research you . Cetrorelix, and Ganirelix) is an essential component in ovarian stimulation for patients undergoing IVF. 1- Gonadotropin-Releasing Hormone Agonist Protocol. Here are five reasons why. 2nd IVF attempt- Antagonist Protocol- very slow to respond on highest doses of meds. In a Lumbalk et al study, it is shown that amongst women with PCOS, the Antagonist protocol has similar success rates but lower rates of hyperstimulation. Below is data collected on over 3,000 cycles for each protocol approach. Personally, and based on the success rates and experience of the IVF patients we've helped over the years, 95% of which were on the short (antagonist) protocol, we think the short protocol is best. The stimulation phase involves the injection of medications for 8-14 days, to induce the ovaries to produce many eggs. The antagonist protocol is generally in women who are donating eggs and in same women who are at risk for not stimulating well with Lupron. However, we do perform modified Conventional IVF when necessary. Cetrorelix, and Ganirelix) is an essential component in ovarian stimulation for patients undergoing IVF. To oversimplify the subject, there are really two core protocols: the "Long Agonist" protocol and the "Antagonist" protocol. They obtained 10 eggs and 9 fertilized with ICSI. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate • Embryo Banking/Stockpiling: Slows the "Biological Clock" and offers a Selective Alternative to IVF-Egg Donation. We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. IVF Lite or Minimal Stimulation IVF has regained favor due to the realization that it is associated with fewer side effects, incurs a lower risk of Ovarian Hyper-stimulation Syndrome (OHSS), has a lower cost and good success rates. 2. The Template for a Long Protocol Agonist Stimulation uses the same principles. IVF success rates typically correlate with the number of eggs retrieved. The C-IVF protocol we use at LIFE is an antagonist protocol. 2014 November 24; 12: 109. benefitted from low rates of nausea and vomiting and a shorter recovery and stay in hospital - often leaving by lunchtime. You'll be given a treatment calendar listing which medications to start on what days. Antagonist protocol. It is a more pleasant protocol for patients, with fewer injections and side effects. following a couple of days at 300. I'm 36 years old, and I had a history of endometriosis (which was completely treated and never recurred for 9 years now), and a diagnosis of poor reserve. . For women using their own fresh eggs, the chances of having a baby on the first cycle are estimated to be:* 7 *Data from 2010 using IVF and ICSI success rates combined in the UK. Also, I don't know what is up with ganirelix, maybe the needle isn't as sharp as the follistim or other needles but you have to really pinch/tighten your skin for that sucker to break skin. During the IVF Cycle. 1) Protocol name - please assign a unique name to the Protocol. Accordingly, I will be put on the microflare protocol next month. This protocol is not our first line treatment because in unselected patients this antagonist protocol has lower pregnancy rates than the Down-Regulation Protocol. following a couple of days at 300. Cetrorelix. There are many controlled ovarian hyper-stimulation protocols for conventional IVF (C-IVF). Page 1 of 3 - Success rates on microflare protocol? A 'long protocol' is the term used when you'll undergo the standard regime used for ovarian stimulation. However, for specific IVF populations, certain protocols and doses are proven to work better. I had success with the antagonist protocol! You can see the success rates of all our clinics seperately on their individual pages, but to give you an overview we have listed the national Live Birth Rate (LBR) as given by the the HFEA , as well as our most recent success rates for comparison. Table 2 involves an older patient cohort requiring the Flare protocol where the CP rate was least on Day 14 (12%). In this way, the gynecologist manages to externally control the process of follicular development in order to obtain a high number of mature eggs in the ovarian puncture. The aim of the present study was to compare the GnRH agonist long protocol with the flexible GnRH antagonist protocol in infertile PCOS women undergoing COS in terms of clinical pregnancy rate (CPR), with special reference to the incidence of OHSS. Key to antagonist IVF schedule: Blood and ultrasound = blood test for IVF hormone values (estrogen levels in IVF stimulation are important) and transvaginal ultrasound to measure the follicle sizes in the ovaries. In this example we will select "Donor egg" and "IVF". Reprod Biol Endocrinol. There are two subtle differences to cover in this lesson: 1) Cycle Day 1 of Stimulation occurs deep in the protocol: in an Antagonist Stimulation the patient begins gonadotropin therapy immediately after the onset of menses.Cycle day 1 of Stimulation occurs on Day 2 or 3 of the Template. Short and Long Protocol. Here we have entered "Antagonist FSH 150 IU". 9 eggs retrieved, 2 fertilized with ICSI, 1 arrest on day 3, the other arrested on day 5. @Ihaveamommasboy, I would bet that the long protocol could have higher success rates because that's the protocol a lot of REs use on younger women or women with fewer issues. GnRH (e.g. Its mechanism of action consists of "slowing down" the pituitary gland and preventing endogenous gonadotropins from acting on the ovary. There was no improvement in fertilization rates when there was a protocol switch. 2 were transferred on Day 5 - BFN. The stimulation phase takes longer if your follicles are slower to mature. Transfered 1 and 5 frozen on Day 3. Inofolic Sachets (inositol + folic acid) Human Growth Hormone. Short Protocol IVF. In conventional IVF two types of protocols are commonly used; the long protocol and the short protocol. There are trials which show that the long agonist and the antagonist protocols offer no real advantage over the other now with respect to the success rate, and there was one which showed that the antagonist had a mild advantage in terms of the pregnancy rate. This information is invaluable when planning a patient's stimulation protocol. Fertilise and freeze - the new IVF trend. . Here, we outline the basic steps you'll follow . Antagonist/Short Protocols. 2) Cycle Type - indicate what sorts of treatments - IVF, donor egg, surrogacy (recipient), FET, ovulation induction - will use this Template. The agonist antagonist conversion protocol refers to a switch in the pituitary suppression drugs during an IVF cycle. Once my follicles were 14mm I went back . The patient may be asked to take 2-3 weeks of OCP prior to starting her cycle. A comparison of microdose flare versus antagonist protocol in poor responders chosen according to the Bologna criteria Neena Malhotra 1, Latika Chawla 2, Reeta Mahey 1, Anupama Bahadur 2, Ashok K Bhatt 1, Alka Kriplani 1 1 Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India 2 Department of Obstetrics and Gynecology, All India Institute of . This typically involves daily injections of a medication to 'switch off' your own ovarian function, which usually starts at around day 21 of your cycle, followed by ovarian stimulation with follicle-stimulating hormones (FSH). Lupron, Buserelin, Nafarelin, and Synarel) or a GnRH antagonist (e.g. However, in low responders, the ovaries are stimulated without pituitary suppression, which may induce asynchronous follicular development. The aim of the present study was to compare the GnRH agonist long protocol with the flexible GnRH antagonist protocol in infertile PCOS women undergoing COS in terms of clinical pregnancy rate (CPR), with special reference to the incidence of OHSS. 8 eggs fertilized. GnRH antagonist therapy. Most patients will do long protocol IVF. My 1st IVF attempt I responded very well (long lupron) to low doses of meds. At LIFE, we specialize in Natural IVF and Mild IVF. In 1978 the first successful IVF procedure was performed without the use of drugs. In conjunction with short/antagonist protocol, the specialist may advise you to take an estrogen patch & possibly a few days of GnRH or even before day-1 of an IVF cycle. For instance, I read somewhere that harvesting eggs slightly sooner for 40+ patients can result in embryos of higher quality. Since then, technology and laboratory techniques have improved dramatically, and the pregnancy rate after transfer of one embryo increased, enabling . Inclusion criteria included patients with an anti-Mü . Natural Cycle IVF. . However, when the protocol stayed the same, the fertilization rate improved only slightly (by 2% - compared to those who switched). By Dr. Geoffrey Sher on 29th August 2016 Consider the fact that between 40 and 43 of age, the success rate per cycle of treatment with injectible fertility drugs alone, with or without intrauterine insemination (IUI) is 2- 3%. The study compared the outcomes of women with an average BMI of 22 with those of 27-28 for each protocol. Recently, GnRH antagonist (GnRH-ant) protocol is widely adopted which are more in line with the physiological processes . . Sperm quality will then be at its best by the morning of your egg retrieval. You may enter multiple values. IVF Cycle Timeline. In the general population, they differ as to pregnancy rates - long protocols are more successful (27.4% pregnancy rate) compared to short ones (23.8%). Since the suppression of follicle-stimulating hormone by OCPs can stay 5-7 days after stopping the pills, it seems that starting the gonadotropin-releasing hormone (GnRH) after 6 days of pre-treatment .